Provider First Line Business Practice Location Address:
12209 131ST PL NE APT C40
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-8049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-766-0801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2026